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Feasibility Study of HIT-Enabled
PROMs in Home Health
Session 175, February 13, 2019
Cynthia Sun, MSN, RN & Gary Rezek, Quality Insights
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Cynthia Sun and Gary Rezek:
• No real or apparent conflicts of interest to report
Conflict of Interest
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• Background
• Barrier / Solution
• Study Description
• Results
• Conclusion
• Considerations for Next Steps
Agenda
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• Describe the feasibility of
integrating HIT-enabled Patient
Reported Outcome Measures
(PROMs) in the home health
setting
• Explain three unique barriers and
possible solutions identified when
integrating HIT-enabled PROMs
in the home health setting
• Discuss impact on home health
patients and clinician workflow
with the integration of HIT-
enabled PROMs
Learning Objectives
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Quality Insights
• Offering health care quality solutions for systems, providers and
patients across the nation since 1973
• Not-for-profit organization that measures and improves health and
health care quality through contracts with federal and state
agencies, foundations and private payers
• More than 200 physicians, nurses, health services researchers,
statisticians, data analysts and educators bringing people and
information together to improve health
• Headquartered in Charleston, West Virginia with offices in
Delaware, Pennsylvania, New Jersey and Virginia
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Background
• Initial plan: Create evidence-based
patient and clinician resources to
improve the home health patient’s level
of self-efficacy
• Barrier: No studies to date have examined using HIT-
enabled Patient Reported Outcomes (PROMs) in skilled
home health care
• Solution: Study feasibility assessing practicality,
integration and acceptability (Bowen et al., (2009)) of
integration of HIT-enabled PROMs into the home health
setting
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Have you used PROMs?
1. Yes via HIT
2. Yes via paper & pencil
3. No, we’re planning to soon
4. Never heard of them
Polling Question
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PROMIS
®
Patient-Reported Outcomes
Measurement Information System
• Validated person-centered measures
• Multiple delivery formats
• Customizable bank of over 300 patient-focused
health outcome measures
• 3 major domains (physical health, mental health
and social health) & Global health
• www.nihpromis.org
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Method
• Pilot Sites: Two home health agencies
– Location: Pacific Northwest
– Patient populations: Urban & Rural
• Duration: Four months
• IRB Approved
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Instrument
• 10 Apple iPads
• PROMIS
®
app
– Self-efficacy for managing symptoms (four items)
– Self-efficacy for daily activities (four items)
– Self-efficacy for managing medications and
treatments (four items)
– Global health measures (10 items)
• Airwatch’s Mobile Device Management (MDM)
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Clinician Training
• Administer during scheduled
home visits
• Answer only by patient
• Inclusion criteria:
– Alert
– Willing
– Able to read English
• Repeat assessment in 2-4
weeks
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Feasibility Assessment
• Combination of surveys,
interviews, and observations
– Patients
– Clinicians
– Administrators
– Information Technology (IT)
staff
• Impact of tablet use on workflow
• Barriers and facilitators of PROM-
data-collection using tablets
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# of elderly community-dwellers needing assistance by 2030
1. 1 million
2. 4 million
3. 12 million
4. 25 million
(Source: Bureau of Labor Statistics)
Polling Question
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Results
• 91 registered subjects with ages
ranging from 31 to 100 (mean 71.9,
median 74)
• Eighty-four patients completed the initial
assessment of tablet-based PROM tool
• Eight patients (9.5%) completed the
follow up assessment
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Results
• 64% of patients were female, 33% male
• 87% of patients were white and 92% non-
Hispanic
• 38% reported their level of education. Of
those patients 72% had at least a high
school education
• Mean assessment completion time was 8.3
minutes (median time 6.1 minutes)
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Results
Relationship between assessment duration (in minutes) and
patient characteristics (N=84)
F
p
df
N*
Race
0.65
0.6917
6,70
71
Ethnicity
0.79
0.4593
2,68
69
Gender
0.00
0.9699
1,68
69
Education
1.37
0.2976
7,20
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Pearson's r
p
N*
Age
0.30313
0.0107
70
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Results
Distribution of primary diagnosis for patients who
participated in the study
Primary Dx group
Count
Examples of Diseases
Included
Orthopedic
42
Fracture(s); Muscle weakness; Aftercare following
joint replacement surgery
Cardiovascular
13
Heart failure; Atrial fibrillation; Myocardial
Infarction; Hypertensive heart disease
Integumentary
8
Surgical wound dressings; Open wound; Pressure
ulcer
Urologic
5
Malignant neoplasm of bladder; Urinary tract
infection
Respiratory
6
Chronic obstructive pulmonary disease with (acute)
exacerbation; Pneumonia
Neurologic
3
Hemiplegia and hemiparesis following cerebral
infarction,
Diabetic neuropathy, Repeated falls
Other
4
Sepsis, Injury of head
N=81 (cases with non-missing diagnosis data)
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Results
• Clinician feedback pointed to areas for improvement of usability
– Preference for finger use rather than stylus
– Sharing of tablets was a logistical hurdle
– Suggestions for aesthetic enhancements to app
– Technical aspects such as security, update message
popups, power saving settings could be disruptive
• A perceived lack of clinical relevance (to the current clinical
process) led to low rate of repeat assessments
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Conclusion
• HIT-enabled PROMs in the home health
setting is suitable for the workflow
• No negative impact on goals of care
• Tablets were found to be practical and
generally accepted by both home health
clinicians and patients
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Considerations
• Patient functional capabilities at
the tool level of PROMIS
®
• Ease of integration of app
collected data into existing EHR
• Future research:
– Test HIT enabled PROMs on
improvement of care quality
and outcomes
– Test on a larger scale
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References
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• Quality Insights: www.qualityinsights.org
• Cynthia Sun: cksun@qualityinsights.org
• Gary Rezek: grezek@qualityinsights.org
• Please remember to complete the evaluations
Questions